For many years I used an approach similar to the one presented by Dr. Nancy Burkhart and colleagues in their August JADA article "Communicating Effectively With Patients Suspected of Having Bulimia Nervosa" (
JADA 2005;136:1130–7[Abstract/Free Full Text]
). However, I found this approach turned my relationship with my patient into an adversarial confrontation. After one look at the eroded lingual and palatal surfaces of the patient’s teeth, I knew the patient had an eating disorder and that the patient knew he or she had an eating disorder. A confrontation would only be counterproductive.
I eventually developed a more direct approach. I would complete my oral examination and, then, facing the patient, I would simply ask, "So, how do you do it? Do you use a spoon, or do you just put your fingers down your throat?" I would say this in an innocuous tone of voice, similar to asking, "So, how was your day?" Before realizing it, the patient would tell me "how" he or she induced the vomiting.
The secret was out. The patient would be embarrassed momentarily by the admission, but also relieved. More importantly, the patient still would see me as his or her ally, rather than adversary. Gaining this type of admission allowed me to ask the more important question, "Would you like me to help you?"
I hope this direct approach will help practitioners avoid the confrontational aspect of diagnosing bulimia nervosa and, thus, allow dentists to be more effective in helping their afflicted patients obtain proper treatment.
